Navigating health insurance can be confusing, especially when it comes to out-of-network care. If you are seeking mental health services from a provider who is not in network with your insurance, you may be wondering how to handle the costs and reimbursements. Understanding how simple the out-of-network process is can make a significant difference in managing your care and your finances.
In this post, we will walk you through the key steps involved in navigating the out-of-network health insurance process. This guide is here to help you understand what to expect and how to take full advantage of your insurance benefits.
Check Your Insurance Coverage
Every health insurance plan is different, and it is important to know the specifics of your coverage. For example, Anthem BCBS typically offers both in-network and out-of-network benefits for mental health services. The first step is to check whether your insurance plan covers out-of-network services.
Some key questions to ask include:
- Do I have out-of-network mental health (outpatient) insurance benefits?
- What is my out-of-network deductible and has it been met for this year?
- How many outpatient sessions per year does my health insurance cover?
Understanding these details will help you plan ahead and avoid any surprises later on.
Know the Payment Process
We find that many plans will reimburse for either all or most of the appointment cost. In many cases, you pay the full cost of each session upfront, and then submit a claim to your insurance for reimbursement.
You will need to include:
- A receipt or invoice from your provider, called a Superbill
- A detailed description of the services provided
- Your provider’s contact information and credentials
Solstice Healthcare provides you everything you need to complete this part of the process.
Submit Claims and Follow Up
Once you have received care, the next step is to submit your claim to your insurance provider for reimbursement. This can typically be done online through your insurance provider’s portal or by fax or mail. Then, payment is sent directly to you either by mail or direct deposit!
If you have Anthem BCBS for example, you can log into your account to track the status of your claim and see any payments that have been issued. If you are unsure about how to submit your claim, contact your insurance provider’s customer service for assistance.
Conclusion
Navigating the out-of-network health insurance process may seem complex at first, but with a little preparation, it can be very simple. Whether you have Anthem BCBS or another insurance provider, understanding your benefits allows you to get the care you want and deserve!
Remember, your mental health is important, and there are ways to make it more accessible, even if you need to go out-of-network. Solstice Healthcare is here to help no matter where in Connecticut you are. Do not hesitate to reach out to our team and complete a new patient form to get started today!
